Psychological "Tools" For Pain Management

Vijai P. Sharma, Ph.D

Over the years I have written many articles on psychological aspects of pain management. In view of the recent bad news about several pain pills (Celebrex, vioxx, Baxtra), people feel defenseless against pain and deprived of options they had come to trust and rely upon.

It is time to seek all the help one can find. Psychological tools are in fact self-help tools that once learned can be used on their own. They do not have to be prescribed or administered by mental health professionals. However, it is very important that you utilize them as a supplement and not as a substitute for your medical pain management program.

If you are someone who is shy of using "mind therapies" because you know your pain is in your body and not in your mind, think again. There is not a part of your body where your mind is not present. Be that any part of the body, if the conscious mind is not present, the unconscious is.

If both conscious and unconscious parts of the mind are absent, the pain would not be felt. If you succeed in totally distracting your mind to something other than pain, you won't feel it in those moments of absolute distraction.

What do pain pills do? They work with the mind at some level. Most pain medications block or diminish pain signals to the mind. Opium derivatives do much more; they anesthetize the mind. The mind is a major player in the perception of pain. Let go of your resistance to the word, "mind." Embrace the idea of utilizing your mind in a positive and purposeful way to modify problems with pain.

Perception of pain is located in the emotional area of the brain. Remember as a young child what you did when you accidentally hurt yourself? Perhaps you did the same thing that other children do. You probably yelled, "Ouch" or not-so-nice a word starting with the letter "s" out of anger. Perhaps, tears flowed from your eyes as a reflexive action.

Why do we get angry or tearful when we feel pain? Because, pain is experienced in the emotional area of the brain! We later on learn to control our emotional response to pain, but it is still there in the brain. Brain imaging studies show that when we experience pain, the emotional areas of the brain light up. Chronic emotional arousal consisting of anger, depression or anxiety often accompany chronic and recurrent pain.

The more you hurt the more anxious, angry or depressed you feel. The more anxious, angry or depressed you feel, the more you hurt. You are caught in a vicious cycle. Therefore, it makes sense to include such tools as diaphragmatic breathing, relaxation, emotional regulations, stress management, meditation or mindfulness as part of your comprehensive pain management program.

And, it works! Instead of giving you examples from my pain patients, I will borrow some of the cases cited in an article "The Right (wrong) way to Treat Pain. Hint: It Takes More Than a Prescription Pad to Really Bring Relief" by Claudia Wallace in the Feb.28 issue of Time. I chose this to be my source document because it supports many of the observations I have made in my previous pain management articles.

Penny Rickhoff , with a damaged spinal cord and severe chronic back pain, used to take a cocktail of narcotics including Vioxx until it was pulled of the market. Now she takes Mobic, practices Tai chi and practices deep breathing using her abdominal muscles. This has enabled her to lower her dosage of narcotics. She walks two miles a day. She admits she can't carry through the day without any narcotics at all, but hopes to further cut down on the use of medication.

Eighty-three year old Bill Highland suffers from constant pain along with occasional episodes of searing pain resulting from shingles. A series of drugs provided only partial relief. Finally, psychologist Ingela Symreng at the pain management center of the University of California at Davis taught him relaxation exercises, deep abdominal breathing, guided imagery of focusing on pleasant mental images, and distraction techniques. Highland has become a master of deep abdominal breathing.

One day, while driving on the freeway, Highland experienced, "horrific shooting pain." Highland put his newly acquired breathing skills at work. He recalls, "As soon as I felt it (pain) I just breathed through my nose and let it go out my open mouth without moving my chest-two or three times." I felt relief almost instantaneously." Hillman uses breathing exercises to quickly bring bad episodes under control.

To demonstrate that relaxation directly works on pain, Dr. Sean Mackey of Stanford University's Pain Management Center uses functional magnetic resonance imaging. By relaxing, patients can watch the lighted brain areas change colors as pain fades. "It is tremendously empowering," says Mackey, "all without medication."

Take your medication as prescribed, but don't forget or hesitate to use the tools that lie in your own tool box.

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Copyright 2005, Mind Publications 
Posted February 2005